Praise for New Evidence-Based 2020 American Red Cross CPR Training

According to the American Heart Association (AHA) “Heart Disease and Stroke Statistics—2020 Update,” more than 347,000 adults in the United States experience a cardiac arrest outside the hospital environment each year. Cardio-pulmonary resuscitation (CPR) guidelines are reviewed, updated, and periodically altered by the AHA. In 2015, this review process changed to an online format allowing for ongoing evidence-based scientific review designed to expedite rapid translation from guidelines to practice (Merchant et al., 2020). The 2020 guidelines also incorporate a new training structure designed to improve both short- and long-term CPR skills.

The training requires an online session (approximately 2.5 hours long) with preassessment questions (with the option to “test out” of certain sections), post-assessment questions, and evaluation tests. Repetition of the information facilitates assimilation of the new guidelines and can be completed at the individual’s own pace. Enhancements include (a) standardization and simplification of the ratios of compressions to breaths; (b) guidelines for in-patient care which differ slightly from outpatient and community care; (c) more specific care of the pregnant patient based on the stage of pregnancy; (d) use of left uterine displacement in a pregnant woman to increase blood flow back to the heart; (e) special instructions for Automated External Defibrillator (AED) pad placement in the pregnant woman, the infant, and small child; and (f) weight guidelines for determining the required level of shock (adult or pediatric; American Red Cross, 2021).

The training emphasizes critical thinking, situational awareness, and closed loop communication. The “Chain of Survival” has been expanded to include recovery and ongoing assessment. Assessment, both initial and ongoing, includes two new areas: disability and exposure. Instead of the traditional reliance on ABC’s (i.e., airway, breathing, and circulation), the new procedures incorporate both assessing and intervening for uncontrolled bleeding and acknowledgment of environmental conditions that must be taken into consideration due to extreme weather. Additional information is provided on managing threats that could make CPR hazardous for either the patient or the provider (or both).

Also useful are tips for handling choking patients in wheelchairs (chest thrusts and back blows), successfully resuscitating children when only adult pads are available (use the adult pads), using the pinky finger to check for an object in a choking infant (to avoid pushing the item further back), altering the resuscitation procedure when arrest is unwitnessed or appears to be due to drowning (begin with two breaths rather than compressions), and clear guidance on when CPR may be terminated. Cardio-pulmonary resuscitation may be discontinued if the patient demonstrates return of spontaneous circulation (ROSC), emergency medical technicians or the code team arrives to take over, a valid Do not resuscitate (DNR) order exists, or the responder is simply too exhausted to continue. Left uterine displacement during CPR in a pregnant patient must be continued until the baby is delivered even if ROCS is attained. Early use of an AED is still recommended in all cases and settings, but a new four-pronged approach to in-hospital surveillance of high-risk patients with constant re-assessment is highlighted.

The new training wisely differentiates between facility requirements and community care. Functional team roles must align with professional scope of practice and the specific setting’s protocols and procedures. Part 2 of the training utilizes high-fidelity simulation for “hands on” experience in handling the equipment and ensuring proper technique. The online course offers the option of printable AHA CPR skill sheets. These skill sheets can be made available in the workplace to build and support high-quality emergency response. The 2020 CPR training is more comprehensive, based on current evidence, and structured to improve CPR skill retention. The occupational health nurse in any setting will clearly benefit from the recent improvements. Rapid expert response with an evidence-based foundation will go a long way toward preventing unnecessary workplace fatalities.